Best to apply by 7/18/25. Job open until filled.

This position is 260 days/year, 8 hours/day. Work calendar is Monday- Friday.

Benefits include: Medical/Vision/Dental Insurance; FSA/DCAP; Life/AD&D Insurance; LTD Insurance; EAP; Retirement; DCP; Annual/Sick Leave, Holiday Pay and Personal Leave.

Required attachments: Transcript, Resume and Cover Letter

Please see the job description below for a list of Essential Functions.

Senior Claims Adjudicator

Purpose Statement

The job of Senior Claims Adjudicator is done for the purpose of evaluating eligibility and processing workers compensation claims in compliance with WCT and state regulations; documenting actions; conveying information regarding claims and benefits; providing testimony as may be required in benefit disputes and acts in the capacity of Claims Administrator as directed in that person's absence; and operating relatively autonomously in bringing claims to closure.

This job is distinguished from similar jobs by the following characteristics: Per the essential functions and educational requirements listed below.

Reports to: Workers' Compensation Claims Administrator

Essential Functions

Primary Responsibilities

Adjudicates worker compensation and related benefit claims including validity, compensation amount, medical aid benefits, and closure of claims for the purpose of ensuring fair and thorough treatment of claims while complying with district, state, and federal policies and regulations.

Analyzes a variety of claims-related information and processes including workers compensation claim status, litigation and sidebar cost, and benefit eligibility for the purpose of determining exposure, identifying high cost areas, and developing plans for remediation.

Attends a variety of meetings including legal training on compensation and related benefits disputes, seminars, conferences, and continuing education courses in workers' compensation for the purpose of ensuring information is shared and received.

Collaborates with a variety of stakeholders including other staff, ESD 113 Safety & Health team, and defense counsel for the purpose of developing solutions to resolve concerns while meeting the goals of the program.

Maintains worker compensation files and records for the purpose of documenting actions and ensuring compliance with district policies, and state and federal regulations.

Prepares a variety of information, documents, and files including statistical summaries, evaluations, reports to excess carrier, and written summaries for the purpose of providing information and documenting activities.

Processes a variety of complex information including employability assessments, claims information required, conservatory procedures, and legal files going to legal authorities for the purpose of ensuring employees are treated fairly while complying with district, state, and federal policies and regulations.

Regular and reliable attendance is required for the purpose of maintaining department operations.

Represents the trust in a variety of situations including mediation at the Board of Industrial Insurance Appeals for the purpose of providing accurate and responsible representation of the trust.

Researches a variety of work-related topics including relevant policies, current practices, claims data, and changing federal requirements for the purpose of providing information and recommendations to the district.

Responds to inquiries from a variety of stakeholders regarding worker compensation and employee benefits including employees, regulatory personnel, and insurance companies for the purpose of facilitating communication among parties and providing information and direction.

Reviews determinative orders for the purpose of ensuring the accurate representation of the Trust's interpretation of the facts of a claim and appropriate actions taken as warranted.

Trains claims adjudicators for the purpose of providing orientation for new claims adjudicators and encouraging the development of professional skills.

Marginal Functions

Assists other personnel as may be required for the purpose of supporting them in the completion of their work activities.

Performs other related duties as assigned for the purpose of ensuring the efficient and effective functioning of the work unit.

Job Requirements: Minimum Qualifications

Skills, Knowledge and Abilities

Skills Required

Skills are required to perform single, technical tasks with a need to occasionally upgrade skills in order to meet changing job conditions. Specific skill based competencies required to satisfactorily perform the functions of the job include:

Operating standard office equipment including pertinent software applications
Preparing and maintaining accurate records

Knowledge Required

Knowledge is required to perform basic math, including calculations using fractions, percents, and ratios; read technical information, compose a variety of documents, and facilitate group discussions; and solve practical problems. Specific knowledge based competencies required to satisfactorily perform the functions of the job include:

Worker compensation programs
State and federal worker compensation regulations and laws
Medical and legal terminology related to worker compensation
Industrial insurance laws, medical aid rules, fee schedules, and appeals procedures
Basic anatomy and physiology

Abilities Required

Ability is required to schedule a number of activities, meetings, and events; routinely gather, collate, and classify data; and consider a number of factors when using equipment. Flexibility is required to independently work with others in a wide variety of circumstances; analyze data utilizing a variety of complex processes; and operate equipment using a variety of standardized methods.

Ability is also required to work with a significant diversity of individuals and groups; work with data of widely varied types and purposes; and utilize a variety of job-related equipment. Problem solving is required to analyze issues and create action plans. Problem solving with data requires analysis based on organizational objectives; and problem solving with equipment is moderate.

Specific ability based competencies required to satisfactorily perform the functions of the job include:

Communicating with diverse groups
Working with frequent interruptions
Working with detailed information
Maintaining confidentiality
Establishing effective relationships
Adapting to changing work priorities
Thinking analytically and critically
Willing to travel throughout the Worker Compensation Trust service area

Responsibility

Responsibilities include working under limited supervision using standardized practices and methods; directing other persons within a small work unit; monitoring budget expenditures. Utilization of resources from other work units may be required to perform the job's functions. There is some opportunity to impact the organization's services.

Work Environment

The usual and customary methods of performing the job's functions require the following physical demands: occasional lifting, carrying, pushing, and pulling, some stooping, kneeling, crouching, and crawling and significant fine finger dexterity. Generally the job requires 5% sitting, 85% walking, and 10% standing. This job is performed in a generally clean and healthy environment.

Education and Experience Requirements

Experience

Job related experience with increasing levels of responsibility is required.

Education (Minimum)

High school diploma or equivalent.

Equivalency

AA degree and 5 years' experience in claims adjudication is preferred, though may be waived in lieu of any combination of education and experience that provides the required knowledge, skills, and abilities of the position.

Must hold a valid WA State Self-Insured Claims Administrator certification, per WAC 296-15-360.

Required Testing, Certificates and Licenses

Licenses Required

Valid Driver's License & Evidence of Insurability
Valid WA State Self-Insurance Certification at time of hire or promotion

Continuing Education and Training

Maintains Certificates and/or Licenses
Recertification test every 5 years

Clearances Required

Criminal Justice Fingerprint/Background Clearance
WA State Sexual Misconduct Disclosure Release

Position Details

FLSA Status: Non Exempt
Salary Grade: 56
Approval Date: None Specified
Revised Date: None Specified

Capital Region ESD 113 is an Equal Opportunity Employer

ESD 113-Senior Claims Adjudicator-Workers Compensation